Radiology Coding Alert

Question: After we performed a sulfur colloid injection under ultrasound guidance for a patient's sentinel node, we sent him to nuclear medicine for lymphatic imaging. Can we report both 76942 and 78195 for these services?

Chicago Subscriber

Answer: CCI Edits 9.0 bundles CPT 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) into 78195 (Lymphatics and lymph nodes imaging), so you cannot report both codes. According to the December 1999 CPT Assistant , "Report code 78195 for lymphoscintigraphy. The -26 modifier is appended to 78195 if only the professional component is performed. The injection of radioactive tracer is included in the lymphoscintigraphy procedure performed at the same session and is not reported separately."

If the radiologist injects the radioactive tracer, and the surgeon then performs a sentinel node biopsy using a handheld gamma detector, however, you obviously would not perform the nuclear medicine imaging described by 78195. Therefore, your practice should report only 38792 (Injection procedure; for identification of sentinel node).

Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga.; and Deborah Churchill, president and founder of Churchill Consulting Inc. in Killingworth, Conn.